This
request is for licensed Health Care Professionals. If you are not
already a customer, you will be contacted to verify the information
given. Thanks....

The staff here is ready to take your call and answer any
questions that you may have. Call 1-800-251-8182. The information
below can be taken by phone if you prefer to speak to someone.

If You
already have a Customer number then enter it in the
License # Field. Also enter Name, Address, Phone etc. for complete
verification.

Name:

Type of Practice:

License #:

Address 1:

Address 2:

City:

State:

Zip/Postal
Code:

Country:

Phone:

Fax:

E-Mail:

If you do not have a fax machine or would rather
call and leave the information, the number is 1-800-251-8182.
We will process the request and send your catalog as
quickly as possible. Thank you for doing business with Dee Cee
Laboratories.